Pancreatitis
Inflammation of the pancreas
Common
Spectrum of Disease
Mild, edematous
- Mild, rapid recovery
- Interstitial edema
Hemorrhagic, necrotic
- Severe, prolonged
- Complications
- Necrosis
Pathophysiology
Autodigestion of the pancreas
- Premature activation of zymogen granules
Pancreatic Protection
- Enzymes stored as inactive zymogens
- Cleaved by proteases in small intestine
- Zymogens and lysosomal enzymes separate
- Pancreatic secretory trypsin inhibitor
Risk Factors
Fat!
- Obesity
- Hyperlipidemia
- Dietary indiscretion
- High fat diet
Endocrine diseases
- Diabetes Mellitus
- Cushing's Disease
Pancreatic factors
- Duct obstruction
- Trauma/ischemia
- Neoplasia
Drugs & Toxins
- Potassium bromide (KBr)
- Azathioprine (Imuran™)
- L-asparaginase (Elspar™)
- Organophosphates
- Furosemide (Lasix™)?
- Corticosteroids?
Additional Risk Factors in Cats
- Trauma (high-rise syndrome)
- Toxoplasma ?
- FIP ?
- Triaditis
- Inflammatory bowel disease
- Cholangiohepatitis
- Pancreatitis
Signalment
Clinical Signs (Feline)
- Lethargy
- Anorexia
- Dehydration
- +/- Hypothermia
- +/- Vomiting
- +/- Abdominal pain
- +/- Dyspnea
- +/- Ataxia
- +/- Diarrhea
- +/- Icterus
- +/- Weight loss
Complications
- DIC
- Acute Renal Failure
- Respiratory distress: pulmonary edema, PTE
- Vascular collapse, shock
- Diabetes mellitus/EPI (chronic or acute recurrent)
Diagnosis
- No pathognomonic test!
- Definitive diagnosis = biopsy
Baseline Bloodwork
CBC
- Leukocytosis with a left shift
- PCV elevated (dehydration)
- Anemia
Chemistry
- Azotemia (prerenal or acute renal failure)
- Elevated LES
- Hyperbilirubinemia
- Hyperglycemia
- Hypocalcemia
- Hyperlipidemia
- Hypertriglyceridemia
Amylase and lipase
- Lack of sensitivity
- Lack of specificity
- If very high (3-4 x baseline) than suggestive
